三叉神经鞘瘤的诊断及治疗(附75例报告)  

Diagnosis and surgical treatment of trigeminal neurinoma

作　　者：周良辅[1] 任力[1] 郭欢欢[1] 

机构地区：[1]上海医科大学华山医院神经外科

出　　处：《中华神经外科杂志》1997年第4期201-204,共4页Chinese Journal of Neurosurgery

摘　　要：目的：介绍三叉神经鞘瘤患者的诊断和治疗经验。方法：对华山医院（１９７８～１９９５）收治７５例三叉神经鞘瘤病人进行回顾性分析。结果：三叉神经鞘瘤病人临床症状多不典型，诊断主要依靠ＣＴ及ＭＲ，本组病例中３４例（４５％）肿瘤在位于中颅窝，２０例（２７％）位于后颅窝，２１例（２８％）呈哑铃型生长。在１９８４年以前，手术多采用硬膜下入路，１９８５年以后逐渐发展了硬膜外入路和硬膜外－经硬膜经小脑幕入路。早期全切率为５８％（２０／３５），近全切４２％，晚期为８０％（３２／４０）近全切２０％。在早期病例的长期随访中有１例死亡，３例复发，颅神经功能损伤的发生率在两组中分别为６３％和２８％。结论：三叉神经鞘瘤显微手术治疗是最佳方法，中颅窝型和哑铃型肿瘤可采用硬膜外入路，后颅窝型仍需硬膜下入路。Objective: To elucidate the diagnosis and treatment for patients with trigeminal neurinoma (TN). Method: A retrospective review of 75 patients with TN treated in Hua Shan Hospital was undertaken. Results: CT and MR are major means for diagnosis of the lesions because of lack of specific manifestations in patients with TN. 34 patients (45%) had tumor limited to the middle cranial fossa, 20 patients (27%) had tumor confined to the posterior cranial fossa (PCF) and 21 patients (28%) had both supra and infratentorial components of their tumors. A series of intradural approaches were used for removal of all tumors located at the sites mentioned above in the early group (1978 1984). An epidural approach or an epiduro transduro transtentorial approach were utilized for all but the tumor only kept within the PCF in the late group (1985 1995). Total tumor removal were achieved in 58% (20/35) in the early group and 80% (32/40) in the late group, subtotal removal were effected in 42% and 20% in the early and the late groups, respectively. One patient (2 9%) died and 3 patients suffered recurrence of their tumors during a long term follow up study in the early group. There were no surgical mortality and tumor recurrence in the late group. Cranial nerves morbidity were 62 7%, 28 1% in the early and the late groups respectively. Conclusion: The best treatment for TN is complete microsurgical removal of the lesions using epidural approach except the tumor only confined to the PCF.

关 键 词：三叉神经鞘瘤 外科手术 脑肿瘤 诊断 

分 类 号：R651.15[医药卫生—外科学]